Choosing Wisely

Along with 80 other medical societies, the American Academy of Dermatology (AAD) recently published a list of unnecessary medical tests and procedures as part of a stewardship effort called Choosing Wisely, orchestrated by the American Board of Internal Medicine (ABIM) Foundation to conserve health care resources. For dermatologists, the list includes:

1. Don’t prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection.
2. Don’t perform sentinel lymph node biopsy or other diagnostic tests for the evaluation of early, thin melanoma because they do not improve survival.
3. Don’t treat uncomplicated, nonmelanoma skin cancer less than 1 centimeter in size on the trunk and extremities with Mohs micrographic surgery.
4. Don’t use oral antibiotics for treatment of atopic dermatitis unless there is clinical evidence of infection.
5. Don’t routinely use topical antibiotics on a surgical wound.

What’s the issue?

Read the list. Assess your current clinical practices. Note where health care waste exists. A November 2013 ABC News investigation noted that hospital charges are the largest source of medical inflation, and I thought to myself, “Yes, think of all the emergency department and inpatients who are reflexively on expensive broad-spectrum antibiotics, or think of the number of patients admitted for stable conditions.” However, from a different standpoint, some might say that dermatology costs are extravagant based on the items on this list, particularly the surgical inconsistencies. Therefore, we should try not to cast the first stone unless our own specialty’s waste is managed. What are examples of regional sources of excess that you can identify?

We want to know your views! Tell us what you think.